Endovascular thrombectomy for mild vertebrobasilar artery occlusion: a hierarchical win-ratio analysis

The study compared endovascular thrombectomy (EVT) with best medical management (BMM) in patients with acute vertebrobasilar artery occlusion and mild neurological deficits (NIHSS score of 10 or less). The analysis included 1,232 patients, of whom 428 underwent EVT and 804 received BMM alone. A hierarchical analysis compared outcomes based on mortality, functional status at 90 days, and symptomatic intracranial hemorrhage. Overall, EVT showed no advantage over BMM (win ratio 0.96, p=0.618). However, in the subgroup of patients with NIHSS scores of 6-10, EVT demonstrated a potential benefit (win ratio 1.36, p=0.004), while in patients with NIHSS scores of 0-5, EVT was less beneficial. The results suggest that EVT may be considered in selected patients with higher degrees of neurological deficit, but its use in patients with mild deficits should remain cautious and individualized.